American Journal of Epidemiology © The Author(s) 2020.Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Vol. 189, No. 5 DOI: 10.1093/aje/kwz279 Advance Access publication: January 7, 2020 Original Contribution Neighborhood Privilege, Preterm Delivery, and Related Racial/Ethnic Disparities: An Intergenerational Application of the Index of Concentration at the Extremes Bina Patel Shrimali * , Michelle Pearl, Deborah Karasek, Carolina Reid, Barbara Abrams, and Mahasin Mujahid * Correspondence to Dr. Bina Patel Shrimali, Community Development Department, Federal Reserve Bank of San Francisco, 101 Market Street, Mail Stop 215, San Francisco, CA 94105 (e-mail: bina.shrimali@berkeley.edu). Initially submitted March 16, 2019; accepted for publication December 13, 2019. We assessed whether early childhood and adulthood experiences of neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE), were associated with preterm delivery and related racial/ethnic disparities using intergenerationally linked birth records of 379,794 California-born primiparous mothers (born 1982–1997) and their infants (born 1997–2011).ICE measures during early childhood and adulthood approximated racial/ethnic and economic dimensions of neighborhood privilege and disadvantage separately (ICE-income, ICE- race/ethnicity) and in combination (ICE–income + race/ethnicity). Results of our generalized estimating equation models with robust standard errors showed associations for ICE-income and ICE–income + race/ethnicity. For example, ICE–income + race/ethnicity was associated with preterm delivery in both early childhood (relative risk (RR) = 1.12, 95% confidence interval (CI): 1.08, 1.17) and adulthood (RR = 1.07, 95% CI: 1.03, 1.11). Non-Hispanic black and Hispanic women had higher risk of preterm delivery than white women (RR = 1.32, 95% CI:1.28, 1.37; and RR = 1.11, 95% CI: 1.08, 1.14, respectively, adjusting for individual-level confounders). Adjustment for ICE– income + race/ethnicity at both time periods yielded the greatest declines in disparities (for non-Hispanic black women, RR = 1.23, 95% CI:1.18, 1.28;for Hispanic women, RR = 1.05, 95% CI: 1.02, 1.09).Findings support independent effects of early childhood and adulthood neighborhood privilege on preterm delivery and related disparities. disadvantage; intergenerational health; neighborhood; preterm birth; privilege; racial/ethnic disparities Abbreviations: CI, confidence interval; ICE, Index of Concentration at the Extremes; NH, non-Hispanic; RR, relative risk. Preterm delivery remains an enigmatic public health prob- lem. Nearly 1 in 10 mothers (9.6%) in the United States delivered preterm in 2015, and troubling racial/ethnic dis- parities persist, with 13.4% of non-Hispanic (NH) black and 9.1% of Hispanic mothers delivering early, compared with 8.9% of NH white mothers (1). Infants born preterm are at higher risk of life-threatening complications in their first days as well as a range of health and educational problems over the life course (2). As understanding of risk factors for preterm delivery has extended beyond behavioral and clinical factors, neighborhood environments have emerged as an important predictor of preterm delivery. A growing body of research links neighborhood condi- tions to poor birth outcomes (3–6), often assessed as depriva- tion (7–11), and an additional body of literature links racial residential segregation to birth outcomes (12). Recently, the Index of Concentration at the Extremes (ICE) has been applied to birth outcomes (13–17), in particular to assess the impact of combined racial/ethnic and economic segre- gation across the spectrum of privilege and deprivation in neighborhoods. Developed by sociologist Douglas Massey (18), 3 ICE measures approximate 3 critical dimensions of privilege: ICE-income focuses on economic privilege by assessing neighborhood concentrations of affluent and poor residents, ICE-race/ethnicity centers on racial/ethnic segre- gation by assessing concentrations of NH white and NH black residents (representing “extreme categories of racial privilege and disprivilege in the United States,” (19)), and 412 Am J Epidemiol. 2020;189(5):412–421 Downloaded from https://academic.oup.com/aje/article/189/5/412/5697353 by guest on 20 August 2022